Burns and scalds – the first ten minutes decide the scar

1. 1Stop the burning. Move away from the source; if clothing is alight, stop, drop and roll or smother with a blanket.
2. 2Cool it under cool running water for twenty minutes. Not ice, not iced water — cool tap water. This is the treatment, and it works for up to about three hours after the burn, so start even if some time has passed.
3. 3Remove rings, watches, bangles and clothing from the area while cooling, unless something is stuck to the skin — then leave it.
4. 4Keep the rest of the person warm. Cooling a large burn can drop body temperature dangerously, particularly in a child.
5. 5Cover the burn loosely with cling film laid over it, or a clean non-fluffy cloth. Do not wrap cling film tightly around a limb.
6. 6Give paracetamol or an anti-inflammatory for pain if there is no reason not to.

Every one of these is still commonly used in South African households, and every one makes things worse — by trapping heat, by causing infection, or by having to be scraped off in a hospital later.

• Butter, margarine, cooking oil or any fat — they hold heat in.
• Toothpaste, which is neither sterile nor cooling and has to be removed painfully.
• Egg white, flour, ash, soil, cow dung or herbal poultices — a serious infection risk.
• Ice or iced water, which causes further tissue damage by constricting blood supply.
• Antiseptic creams or ointments before assessment, which obscure the wound.
• Cotton wool or fluffy dressings that shed fibres into the burn.
• Do not burst blisters. They are a sterile natural dressing.

A painless burn is not a mild one. Loss of sensation means the nerve endings have been destroyed, which is a sign of a deep burn rather than a good one.

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• Chemical — brush off any dry powder first, then rinse with large amounts of running water for at least twenty minutes, longer for a strong acid or alkali. Remove contaminated clothing while rinsing. Do not try to neutralise it with something else.
• Chemical in the eye — rinse the eye continuously with clean water for at least twenty minutes, holding the eyelid open, and go to hospital while rinsing if you can.
• Electrical — switch the power off before touching the person. The visible burn is often small while the damage underneath and to the heart rhythm is not, so every electrical burn needs assessment.
• Call the Poisons Information Helpline for any chemical exposure; they will tell you exactly what that substance needs.

Most serious burns in South African children are scalds from hot liquid and burns from paraffin stoves, candles and open fires — and most happen in the kitchen.

• Turn pot handles inward and use the back plates.
• Never hold a child while carrying or drinking something hot.
• Keep kettles, kettle cords, hot drinks and pots away from edges and out of reach.
• Keep paraffin in a clearly marked container that cannot be mistaken for a cool drink bottle, and never under a bed or within a child's reach.
• Put candles in a stable holder away from curtains and bedding, and never leave one burning in an unattended room.
• Set or check the geyser thermostat, and always run cold water into a bath first, then add hot.